- Hello, and welcome to this episode of the
- Physics World weekly podcast,
- which is sponsored by one physics.
- Our guest this week is James Gilts of
- one Physics.
- In a wide ranging conversation with Physics World's
- Tammy Freeman,
- Gilts explains how the company provides comprehensive
- medical physics support
- for radiotherapy,
- from planning new centers through to ongoing
- clinical operations.
- That conversation is coming up after this message
- from our sponsor.
- One Physics is The USA's
- largest outsourced medical physics provider,
- trusted by over 4,000
- clients.
- We proudly deliver diagnostic and therapy physics services,
- linear accelerator commissioning,
- dosimetry
- treatment planning, and radiation
- safety officer services
- nationwide.
- We are experts in medical physics services
- and radiation
- safety
- and can support your organization,
- whether you need annual physics testing to meet
- regulatory
- guidelines
- or are looking to implement
- a theranostics
- program.
- We are experts in all areas related to
- physics and radiation safety.
- With national scale and a local
- relationship driven approach,
- our best in class physicists
- bring precision and personalized care to every facility
- we serve.
- In the world of medical physics, precision
- isn't optional.
- It's everything.
- One Physics,
- your trusted partner in medical physics,
- linear accelerator commissioning, and radiation safety.
- Learn more about our approach to radiation safety
- or schedule a personalized
- consultation
- at 1physics.com.
- Radiation therapy is an essential component of cancer
- care and is used in the treatment of
- roughly half of all cancer patients.
- To ensure that these treatments are both safe
- and effective, it's critical that the linear accelerators
- or LINACs
- that deliver the radiation
- are as reliable,
- efficient, and accurate as possible.
- The US based medical physics consultancy,
- One Physics,
- aims to help hospitals and cancer centers meet
- these goals
- by bringing together a team of highly trained
- expert medical physicists
- to provide a wide range of radiotherapy
- and diagnostic imaging physics services.
- I'm speaking today with medical physicist James Gilts,
- director of commissioning services at one physics,
- about the importance of linac commissioning
- and how the company works with health care
- organizations
- to optimize patient safety and clinical efficiency.
- Welcome to the podcast, James.
- Thank you. Thank you for having me.
- So could you start by giving a quick
- introduction to the services that One Physics offers
- and your role in the company?
- Absolutely. So
- One Physics is a comprehensive medical physics services
- company. We,
- like to do what I think some of
- my colleagues would call,
- cradle to grave physics support.
- So we can support a center that is
- not open yet,
- all the way through its planning as it
- relates to physics,
- through its opening as they install machines, qualify
- them through either diagnostic or therapy services,
- and then provide continuing physics support,
- while they're open, either with direct physics staffing,
- software tools,
- ancillary contracts, those sorts of things.
- My role in the company is to
- address some of those ancillary
- contracts and initial services.
- So my team comes in and commissions machines,
- performs shielding surveys,
- shielding design calculations,
- things of that nature.
- Okay. So can you explain what the in
- app commissioning actually involves?
- And why is it so important for radiotherapy
- based cancer treatments?
- Absolutely.
- I kinda wanna answer those in the opposite
- order.
- The LINAC commissioning is critical to any radiation
- therapy department because as the treatment teams are
- designing and delivering
- these care plans for patients,
- in order for those plans to be
- generated,
- a treatment planning system has to have a
- comprehensive
- model of the accelerator that's gonna be used
- for treatment.
- And
- these models
- have to be as precise as possible so
- that we can take care of patients and
- treat them efficiently and effectively.
- What we have to do in order to
- achieve that is
- take a very, very large set
- of data about the beam coming out of
- the head of that machine.
- This is a dataset that is more expansive
- than would be taken at any other time
- during the machine's life,
- taken with as many settings
- as
- practicable
- for that system.
- So how can one physics help in this
- commissioning process?
- So
- we have a team that is dedicated to
- commissioning. This is, staffed by physicists who are
- commissioning machines routinely
- and,
- using tools and techniques that we've developed over
- the years as we have commissioned more accelerators
- than any other group in America.
- This team
- spends a great deal of time and effort
- mastering
- this process
- and learning
- for exactly what they should be looking for,
- how these machines should be reacting,
- and the consequences
- of various measurements
- behaving differently than expected, and what that could
- mean
- for the system, whether the machine needs to
- be retuned, recalibrated,
- or whether,
- it can be modeled effectively and safely.
- We also
- have so much data from the machines that
- we've commissioned that we can check
- all of the machines we commissioned in a
- sort of three pass methodology.
- We compare the machine against,
- our own internal aggregates,
- which are representative datasets from the machines that
- we've collected historically.
- We can compare them against the vendor representative
- data. So the,
- the data that the vendors believe is their
- representative machine.
- And then we also do a comprehensive point
- by point comparison
- from their own treatment planning system. Once we've
- built the model,
- we calculate all of the fields, all of
- the output factors
- that we took
- during
- measurement
- and do a direct comparison to ensure that
- the model is as precise as possible to
- reality.
- Okay. And and then what was the benefits
- for a hospital or a cancer center,
- of using
- a third party commissioning service,
- for example, rather than the on-site physicists
- just doing this work themselves?
- That's a great question. There there's a lot
- of advantages
- depending on what that hospital is specifically looking
- for.
- One of
- the big ones
- that is important in the modern day of
- healthcare as costs are getting tightened, constraints are
- increasing,
- is that we are so proficient at doing
- this work that we have very rapid turnarounds
- for these commissioning jobs.
- A a typical site physicist
- who maybe is performing a commissioning once every
- ten,
- fifteen years,
- is going to rightly
- take a very long time
- to take these measurements and double check their
- work and be as diligent as they're able
- to be,
- with their relative lack of experience in the,
- in the medium.
- We typically complete commissionings
- in a two to three day time frame,
- collecting all of the data, building the treatment
- models, and validating those models, and then hand
- it back to the site physicist to do
- their final end to end testing.
- This can get clinics online much faster
- than they would be if they were using
- internal services.
- And then secondarily to that, there are
- concerns, I would say, if you have an
- on-site physicist who does not have the experience
- that a dedicated third party commissioning team has
- that doesn't have the sets of data to
- compare to that we have where mistakes could
- slip in to the data. Something could get
- calculated incorrectly. An error could be made in
- measurement,
- and it's much harder for the standalone on-site
- physicist to identify those faults.
- That is part of why it rightly takes
- them so long to accomplish the work. But
- even with that extra time that they spend,
- there are literally thousands of data points that
- they need to be checking and verifying. It's
- very easy for something to slip through.
- And is it also important that the client
- uses a an independent
- provider to commission a linac?
- Absolutely. I think one of the pillars of
- the medical physics community is, you know, independent
- third party checks.
- Most clinics, whether through regulation or just good
- practice, use something like IIROC that does a
- third party output validation of their machines.
- You know, their, their on-site physicist, I'm sure
- is doing good work and is doing the
- best that they can when they calibrate the
- Linux, but we're all human and can make
- mistakes.
- So having that third party check of IIROC
- gives confidence to the clinic, to the physicist
- that's on-site, and ultimately to the patients that
- their machines are calibrated correctly.
- In the same way, a third party commissioning
- service,
- especially one that goes through the extra effort
- to check it against as many datasets as
- possible,
- can provide a great deal of comfort to
- the facility and to the on-site physics that
- their machine is modeled well.
- Okay. So One Physix uses, they have some
- proprietary software, a tool called Quadrant.
- What what's this? How does it work, and
- and what advantages does it offer?
- Yeah. So Quadrant is a software that was
- developed
- many, many years ago. I guess the first
- version of Quadrant was developed many years ago
- specifically for some of these reasons.
- My predecessor, Mark DeWeese,
- was
- going around the country commissioning machines
- more than I think most people would be
- willing to in the modern era. He gave
- up a lot of his time,
- a lot of his personal life to commission
- the
- swath of machines that he had experience with.
- But as a lot of people did historically
- before some of these new technologies got developed,
- he was still performing
- a lot of the analysis for these data
- in Excel sheets
- and, you know, manual reviews
- of Microsoft Office documents where he had to
- just look and check with his eyes to
- confirm these things.
- At some point, he realized that this was
- just a very tedious error prone process and
- that even though he was very good at
- it, very experienced and he knew what he
- was looking for, again, he was a human
- and
- something like that is the highest risk
- point for someone performing commissionings.
- So he hired software developers and custom created
- software
- that would specifically
- take the data that we take from these
- water tanks
- and analyze it at speed with the precision
- of a computer so that it could kick
- out,
- variations,
- errors,
- odd readings,
- and give objective
- full field analysis
- of all of the data so that he
- initially could be individually confident in what he
- was doing.
- We've since developed that software to be
- incredibly powerful. We're able to use it to
- analyze and process data faster than anyone else,
- and to a much greater extent.
- Our data pace can process hundreds of thousands
- of points
- in seconds
- and provide large scale reports
- for clients and for us.
- So this is what you'd you'd always use
- if if someone from One Physics goes to
- do the commissioning, they'd always use the Quadrant
- tool?
- Absolutely. Quadrant is integral to the work of,
- I would say, in general, it's integral to
- the work of most physicists
- at one physics regardless of what service they're
- providing. But certainly on the commissioning and ancillary
- services team, Quadrant
- is absolutely integral to what we do. You
- know, some some of our commissioning physicists might
- be working
- very long days to get all of this
- data collected in a timely manner, ten to
- twelve hours.
- And we have the software that as we're
- working,
- if
- one of the team does do something stupid
- as we are also humans, the software will
- alert us immediately to that and say, you
- know, hey. This reading you just took doesn't
- make sense.
- Are you sure? Go back and look at
- it again.
- And now we don't have to worry about,
- Oh man, did
- we accidentally upload it, say a 10 X
- beam? Is it 15 X beam?
- And
- now we have to do secondary analysis, maybe
- come back to site. All of that stopped
- in advance. We get a near immediate feedback
- to a high level of precision
- about, is this data good? Is this data
- representative of this type of machine?
- Is this something we can use to model?
- And and you mentioned a couple of times
- that it makes the commissioning faster.
- Why is that so important for health care
- centers?
- So speed, again, I I kind of alluded
- to this earlier, but the way that the
- health care industry is moving,
- nowadays with changing to reimbursements
- and,
- just kind of general
- production requirements
- that hospitals need
- to stay profitable, to stay solvent, whether they're
- for profit or not for profit.
- They need to be operating
- the high value services like radiation oncology
- as much as
- practicable.
- So,
- you know, you can imagine you're
- you're some hospital, you've spent $10.15,
- dollars 40,000,000
- opening up this new cancer center. That's a
- very large line item on your book,
- and
- you need to recover that money to stay
- solvent. You need to perhaps,
- be independent of the financial aspect,
- this community has a need for cancer care.
- You know, maybe this is a rural center
- that's hours away from the nearest major metropolitan
- area where these services are available. And you
- have patients now
- that need therapy.
- By using,
- third a very fast and efficient third party
- service like OnePhysics,
- we can take that maybe four week timeline
- that your site physicist might be using and
- compress it into only a few days.
- We work over weekends. So as you know,
- they maybe the machine installer finishes
- on a Thursday or Friday,
- we'll be there all weekend taking that data
- and modeling the machine.
- And frequently, we're able to hand the data
- book and models back to the site the
- following Monday so they can get going and
- get ready for treatment.
- Excellent.
- So and then once the LINAC is being
- used to treat patients,
- can Quadrant be used,
- after commissioning for for other things?
- Yes. In fact, that's something that, again, I've
- I've mentioned that Quadrant
- continued to get developed over time.
- One of the things we realized once we
- had this database
- of the initial commissioning data that we took
- on these machines
- was that our periodic QA that physics performs
- either monthly or annually,
- the reference that we always set
- is to the initial commissioning data. You know,
- we want to confirm
- that the machine is not drifting away
- from that information that was entered into the
- treatment planning system. We want it to be
- consistent
- day after day, year after year.
- Well,
- given the fact that we have that initial
- data,
- we realized that it would be very easy
- to construct different tools and utilities to perform
- some of these required tests that you see
- in documents like t g one forty two
- and have a
- instant
- accurate comparison
- to the original commissioning data.
- So we've developed that
- configuration within Quadrant,
- which also helps us to either on some
- of the sites that we provide PhysX service
- directly
- or some sites that reach out to us
- to take off some of the QA load
- from them and perform either monthly or annual
- QAs.
- We can perform those periodic QAs also at
- speed to a high level of objective accuracy,
- referencing their commissioning systems.
- So and you mentioned that so One Physics
- also offers as well as commissioning, you offer
- services such as annual or monthly QA.
- Are there any other services within radiotherapy?
- Yes. Absolutely. So I I think that
- we try to be as much of a
- one stop shop as we can. Right?
- So from an ancillary contract perspective, we absolutely
- offer monthly and annual QA services as needed.
- This is becoming a more common ask as
- the shortage of medical physicists is really constraining
- the available efforts of local physicists.
- We can take the these, you know, forty
- plus hour QAs and compress them into a
- weekend
- so that your site physicist doesn't have to
- spend that time and can instead focus on
- their local patients.
- But we also offer various validations for sites
- that maybe want to get into stereotactic treatment
- that were not originally intended for that. We
- can
- come in, work on that system, quantify it,
- provide good recommendations and new sets of specific
- small field data so that they can treat
- some of these smaller, more aggressive lesions.
- We perform shielding surveys and analyses. So if
- something
- happens or we're installing new equipment,
- we'll come out and do a comprehensive shielding
- evaluation
- that's compliant with NCRP one fifty one and
- provide that so the physicist doesn't have to
- go back and
- pick up a bunch of meters and design
- their survey. We have systems set in place
- to do it at speed.
- So that's I mean, you've got quite a
- broad portfolio of services there. Is it mostly
- the smaller clinics that are looking to outsource
- these medical physics services?
- You know, it's a it's a combination,
- honestly, and I think that different people outsource
- for different reasons.
- As you mentioned, oftentimes, it is these small
- clinics. There's a center that
- I recently was assisting with annual QAs that
- is in a very rural area of the
- South, and they have a physicist that has
- to drive,
- three hours, one day a week to provide
- them some amount of physics service because there
- is just no one else out there.
- That physicist is doing that in addition to
- his normal
- weekly workload at the center that he works
- at in a more major metropolitan area.
- So he's already stretched incredibly thin. This is
- this is someone who does not have the
- time or capacity to perform annual QAs for
- this clinic
- despite their desire to help.
- So we are filling that gap in that
- rural community so that they can continue to
- provide quality cancer care. But on the flip
- side,
- we've also had contracts
- with,
- some major universities
- for commissioning work or for shielding work, for
- example.
- And I think the biggest bit of feedback
- I get from those institutions
- is that they did want
- a third party service of experts to come
- in so that they didn't make an error,
- Right? These are physicists that are working
- constantly, but they're working constantly
- in a very high
- stress, very high throughput environment,
- working on direct chart checks, patient care, these
- kinds of things. And they haven't commissioned a
- machine in fifteen years.
- They don't want their machine to end up
- coming out with an error just because of
- an oversight.
- And so they they come to us for
- that independence, for that
- quality that they know that they don't have
- to worry about what it's going to be,
- and we're gonna give them all of that
- data to review so they can have the
- utmost level of confidence in their systems
- while they're working these incredibly long hours.
- Okay. And and so you've mentioned that there's
- sort of a shortage of on-site medical physicists
- in some areas. Is this a trend that
- you're seeing within medical physics?
- Absolutely.
- So there's
- there's been a shortage kind of I I
- used to say there's a shortage on the
- horizon,
- ever since the residency requirement got put into
- place to get boarded in medical physics, which
- was very necessary.
- Support and expertise that they were getting.
- But that
- that requirement
- created a bottleneck,
- and the amount of physicists that can that
- can enter residencies and complete them each year
- is now below the threshold
- that, really, that the industry needed to kind
- of maintain full physics staffing throughout the entire
- country.
- And so now we're starting to see,
- as physicists have retired and the as the
- general shift of the labor force has moved
- in that direction,
- there's simply not enough bodies
- to cover all of the cancer centers throughout
- the country that we need to take care
- of these patients.
- That's not
- something that's easy to solve. There are a
- lot of organizations
- that are working as hard as they can
- to try and get more quality physicists out
- into the market so that we can fill
- this need. But at the moment, I think
- anyone who's been trying to hire recently will
- note
- it's a challenge, especially if you're in a
- rural area to find someone
- who
- is even willing to talk to you to
- come out. There's just not enough of us.
- Gosh. And this is due to this residency
- requirement that you mentioned?
- I I think that was the initial driving
- force. Again, it's
- it's a very important requirement.
- You know,
- very historically
- when we were doing cobalt teletherapy,
- there wasn't nearly as much to medical physics.
- But as time has gone on, as technology
- has increased so much,
- there really is a requirement for a
- reinforced
- stout education for physicists that are practicing in
- the field.
- The residency
- requirement makes sense. I myself actually am a
- residency
- instructor
- in a partnership with a university,
- and
- there are a large amount of physicists that
- are working very hard to produce as many
- quality residents as we can.
- But, again, the field
- is just so complex, and there are so
- many places throughout the country that need physics
- support that we're running into a shortage.
- So, I mean,
- final question. You know, with this increased need
- for medical physicists,
- what are the opportunities
- for those interested in working in this field?
- Does one physics
- have any residency programs it can help with?
- We do. We do. As I mentioned,
- I'm an instructor in a residency program that
- is partnered with the university specifically, so I'm,
- you know, technically in a university
- residency
- system.
- But one physics separately from that
- has, I believe, four residencies
- in therapy and one
- in diagnostic physics, and they're expanding as much
- as we can make them. There's a significant
- push
- from the administration of one physics recognizing this
- need in the community
- to increase the amount of quality physicists that
- are being produced.
- We've hired,
- medical physics assistants
- at some centers where that makes sense,
- that are folks that are trying to get
- into the field, and we've spent a fair
- amount of time attempting to leverage those medical
- physics assistants into our residencies.
- Residency. I think that's a common
- experience for people who graduate with their degree
- and don't immediately match to a residency. They
- end up being a medical physics assistant.
- We we try and find people who are
- qualified in this way, give them some additional
- kind of on the job training,
- and then
- leverage them into residencies and try and get
- them trained so that we can get them
- boarded and have them actively participating in the
- field of medical physics at the highest capacity.
- Excellent. So the company is sort of helping
- to train the medical physicists of the future.
- As much as we can. Absolutely.
- Brilliant. Right.
- Okay. Well, that's great. Well, thanks very much
- for talking with us today.
- Indeed. Thank you for having me. It's been
- a pleasure.
- That was James Gilts of one physics
- in conversation
- with physics world's Tammy Freeman.
- I'm Hamish Johnston, and our producer is Fred
- Iles.
- The music for this episode is called one
- three seven,
- and it was composed and performed
- by the physicist
- Philip Moriarty.
- One Physics is The USA's
- largest
- outsourced medical physics provider,
- trusted by over 4,000
- clients.
- We proudly deliver diagnostic and therapy physics services,
- linear accelerator commissioning,
- dosimetry
- treatment planning,
- and radiation safety officer services
- nationwide.
- We are experts in medical physics services
- and radiation
- safety and can support your organization,
- whether you need annual physics testing to meet
- regulatory guidelines
- or are looking to implement a theranostics
- program.
- We are experts in all areas related to
- physics and radiation safety
- With national scale and a local relationship driven
- approach,
- our best in class physicists
- bring precision and personalized care to every facility
- we serve.
- In the world of medical physics,
- precision isn't optional.
- It's everything.
- One Physics, your trusted partner in medical physics,
- linear
- accelerator commissioning,
- and radiation safety.
- Learn more about our approach
- to radiation safety,
- or schedule a personalized
- consultation
- @1physics.com.